| NPI | 1376501262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHONDELL L GANTZER Bookkeeper 701-858-0115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2007-10-25 |